U.S. Halts Gene Therapy Studies Over Risk
It marks the second time in three months that health officials have
interrupted gene therapy studies because of the grave side effect.
Bubble boy disease — an immune disorder formally called severe
combined immunodeficiency, or SCID — is the only disease ever to be
cured with gene therapy. But three months ago, a boy whose life was
saved by a SCID gene therapy experiment in France when he was a baby
came down with a leukemia-like syndrome at age 3.
Scientists have long warned that cancer is a possible risk from any
gene therapy, such as that for SCID, that uses retroviruses, a type of
virus that permanently invades cells, to deliver new genes into a
patient's body. Still, no one given gene therapy for SCID or other
diseases had ever had such a side effect.
That first sick toddler prompted U.S. and French scientists in
October to stop gene therapy experiments for SCID, including three in
this country.
Now a second child in the French SCID experiment has come down with
that same leukemia-like side effect, Food and Drug Administration (news
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web sites) scientists announced Tuesday.
Quietly notified by French researchers about a month ago, the FDA
decided that the second serious side effect warranted the more serious
response: temporarily stopping about 27 more U.S. experiments that use
retroviruses to insert new genes into blood stem cells in hopes of
fighting diseases other than SCID.
The FDA didn't release a list of the experiments but said they
include some targeting such diseases as cancer and include several
hundred participants.
The FDA said if researchers argue that any of the retrovirus
experiments offered a sole option to people with life-threatening
illnesses, the agency would work to let them restart on a case-by-case
basis, with appropriate warnings to participants.
The three SCID gene therapy experiments, however, remain on hold for
at least a few more months while officials investigate the second side
effect, FDA officials said.
"We do think it's a prudent course," because "there are things going
on here that we really don't understand," FDA gene therapy chief Dr.
Phil Noguchi said.
The FDA will convene its scientific advisers next month to pore over
the research and debate future steps.
"It's very unfortunate that with the first real success in a very
difficult disease, that there's this downside," said American Society
for Gene Therapy president Joe Glorioso, a University of Pittsburgh
geneticist.
Without the gene therapy, these two boys almost certainly would have
died of their SCID because they had no other treatment options, he
noted. Yet without the gene therapy, he said, "it's unlikely these
patients would have ever developed leukemia."
Both boys responded well to chemotherapy and are stable, but their
long-term outlook is uncertain, Noguchi said. He released few details
about the second patient, including his nationality, other than that he
was cured of SCID as a baby and became ill with the cancer-like syndrome
almost three years later.
SCID babies are born without the ability to produce disease-fighting
immune cells. The best known victim was David, Houston's famous "bubble
boy" who lived in a germ-proof enclosure until his death at age 12 in
1984.
There are some SCID treatments, including bone marrow transplants
that can allow patients to live normal lives. But transplant success
varies widely, and many children still die young.
So Paris' Dr. Alain Fischer generated great excitement when his gene
therapy apparently cured nine of the 11 boys he treated who had the most
severe SCID-type, called X-SCID. He drew bone marrow from the boys,
culled immune cell-creating stem cells from it, and mixed in a virus
containing the gene their bodies lacked. Injected back into their
bodies, the stem cells worked properly.
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On the Net: FDA announcement:
http://www.fda.gov/bbs/topics/ANSWERS/2003/ANS01190.html